Poor Communication in Cancer Care

Patient Perspectives on What It Is and What to Do About It

Sally Thorne, PhD, RN, FAAN, FCAHS; John L. Oliffe, PhD, RN; Kelli I. Stajduhar, PhD, RN; Valerie Oglov, BSW, MA; Charmaine Kim-Sing, MD, FRCPC; T. Gregory Hislop, MDCM, MSc

Disclosures

Cancer Nurs. 2013;36(6):445-453. 

In This Article

Why the Formal Evidence Remains Inconclusive

Although the extensive body of research and the significant number of systematic reviews confirm an explosion of interest in the challenge of cancer care communication, they have yielded inconclusive evidence to support efforts to standardize approaches to communication. Although many authors claim that high-quality, controlled, quantitative studies would benefit the field, few critically examine the reasons why conventional methodologies have not yielded definitive findings.

Systematic reviews rely on quantified results conducted within controlled conditions. This is problematic in the study of cancer communication for several reasons. Such studies focus on common experiential elements of the communication experience, such as "bad news" transmissions, attempting to distill them from the complex contexts within which they naturally occur. They also rely on inherently imperfect outcome measures, such as use of emotion-focused language or patient satisfaction scales, which are not particularly representative of an experience in its entirety. For the most part, quantitative investigations of discrete components of communication fail to generate reproducible findings because they ignore the balance of content and context required when complex biomedical issues must be integrated with patient-centered values.[35,36] Thus, by trying to distill from the total body of potentially useful empirical science only that which conforms to conventional ideas about evidence, quantitative communication research tends to generate dubious meanings that can complicate, rather than clarify, understandings of the inherently experiential lived reality that communication entails, with all of its unique and individualized variables.

We approach our work in this field from the foundational assumption that communication is inherently "complex and messy," especially when emotions such as anxiety and fear are involved. Patients and professionals bring complexity to the process, and the care contexts in which cancer care communication occurs are highly dynamic, often changing in profound ways as a cancer journey evolves. Although we can extract from the empirical research and clinical wisdom a number of general principles from which to generate "best practice" understandings, these may be inadequate in accounting for the infinite range of nuances and diversities when difficult and emotive concepts are transmitted between 2 or more people.[37] The science of communication in cancer care is therefore inherently imperfect. Because of this, the advancement of clinically relevant knowledge must be approached with an appreciation for the limits of what can be generalized about populations that will apply to the individual particularities that constitute real-life patient care.[38,39] In this context, qualitative and longitudinal research approaches help contextualize the meaning of what we can learn from measurement and population-based studies and could provide us with a viable way forward.

Although it has been difficult to make confident claims about what constitutes good communication, there is much to be learned from thoughtful consideration of what contexts give rise to poor communication. Constructivist problem-based learning approaches have also capitalized on this approach, engaging healthcare trainees in clinical scenarios whereby they can deconstruct mistakes and generate solutions. Therefore, by focusing on what makes communication poor, we are also deeply invested in addressing "what to do about it."

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